Playing Chicken Health: Getting pox as a child grants immunization for life from the more dangerous adult form. An expensive shot can't promise the same. So, parents of XTC never-infected youngsters face a tough choice.

April 09, 1996|By Patricia Meisol | Patricia Meisol,SUN STAFF

Wanted: Someone with a case of chicken pox bad enough to pierce 12-year-old Danny Mroz's healthy armor.

He and a 10-year-old sister, Emilee, have ducked the common childhood disease for years despite what their mom, Sandy, estimates were six known exposures and thousands of possible carriers in playgroups, classrooms and soccer fields.

"I've been trying to expose him to it since he was 5," she says.

With only a year before Danny turns 13, when a case of chicken pox can be more serious than one endured in early childhood, Mrs. Mroz is torn over whether to hold out a few more months or give him the new chicken pox vaccine that arrived in doctors' offices across the country a year ago.

To vax or not to vax. That is the question for the doctors and parents of nearly 4 million children born this year following the introduction of a vaccine that could put chicken pox in the same category as German measles: obsolete.

On the one hand, chicken pox is a big problem -- 4 million children a year get it and the American Medical Association estimates it costs $384 million every year in missed work for parents and hospitalizations.

On the other hand, do children need a vaccine for what is usually a mild disease? Will the protection last into adulthood? If immunity wanes and a person catches the disease later in life, it can be more serious.

World experts in chicken pox, including Neal Halsey, pediatrics professor at the Johns Hopkins School of Hygiene and Public Health, strongly support the vaccine for all children beginning at age 1.

"Children with chicken pox do suffer," says Dr. Halsey, a member of the American Academy of Pediatrics' committee on infectious diseases. "It's the child suffering and it's the serious complications" that beg for the vaccine, he says. "If we can prevent 50 to 100 deaths a year, it's worth it."

Between 5,000 and 10,000 children and adults are hospitalized annually because of the disease and its secondary effects, including the strep virus, pneumonia, and brain damage from encephalitis. "That is probably an underestimation of the true complications that occur," Dr. Halsey says.

Recently in California, researchers found an increased link between varicella, the chicken pox virus, and group A strep, after studying cases including the 1994 deaths of eight children within three weeks from strep. All of them had also suffered from chicken pox.

The vaccine's manufacturer, Merck & Co., is expected to sign a contract with the Centers for Disease Control and Prevention in the next few weeks to provide the vaccine for children in public immunization programs. They represent about 60 percent of the eligible population.

But the vaccine isn't taking off in private doctors' offices the way some expected -- despite strong stands by the American Academy of Pediatrics and the CDC in favor of universal immunization. Many doctors -- about half those in Maryland -- are recommending the vaccine only gingerly for younger children -- babies though pre-teens.

The reasons include its cost, about $60, the relatively mild nature of childhood chicken pox and questions about whether the vaccine will provide the same lifetime immunity afforded by the natural strain of the disease.

"The concern is, it works, but it doesn't last," says Leonard Raucher, a family doctor in Ellicott City. Real chicken pox, he says, makes you immune for life. "I'd hate to see it happen that we take a whole generation of kids to adulthood without the natural immunities."

In early childhood the disease is often considered more irritating than serious. Its first sign is a high fever, followed by quick outbursts of anywhere from 10 to 500 lesions. As the lesions break open and form scabs, they can be severely itchy.

Since May 1995, more than 2.3 million doses of the vaccine have been ordered by doctors' offices, according to Merck. A Merck spokeswoman says the orders represent about the same initial acceptance rate, about 50 percent of those born every year, that greeted the measles vaccine when it was launched in 1963. In contrast, the acceptance rate for hepatitis B, introduced in 1991, is only about 20 percent.

But some of the sales may be to doctors who are pushing the new vaccine not for babies but for 11- and 12-year-olds like Danny Mroz and for adults who've never been exposed. Doctors pretty much agree that teen-agers and adults who haven't already had a natural case of chicken pox should get the vaccine. At that age, complications from chicken pox are more common and more serious.

A tough call

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